Surgical management of aqueous misdirection by endoscopic vitrectomy with Hyaloido-Zonulo-Iridectomy

To assess the outcomes of surgical management of aqueous misdirection (AM) by endoscopic pars plana vitrectomy with hyaloido-zonulo-iridectomy.

In this prospective, longitudinal, noncomparative interventional study, 53 eyes from 46 patients with AM refractory to medical and laser therapy after intraocular surgery were enrolled. All eyes underwent lens removal (if phakic), endoscopic pars plana vitrectomy, and hyaloido-zonulo-iridectomy. Primary outcomes included intraocular pressure (IOP), best-corrected visual acuity (BCVA), anterior chamber depth (ACD), postoperative complications, relapse rate, and composite surgical success. Surgical success was defined as the combination of IOP control and anterior chamber reformation, using two alternative IOP thresholds ( ≥ 6 and ≤18 mmHg, or ≥6 and ≤21 mmHg). Continuous variables were analysed using linear mixed models and expressed as estimated means (est)± standard error.

Mean age was 59.7 ± 12.2 years. The est. IOP decreased from 34.36 ± 0.82 mmHg to 17.47 ± 0.82 mmHg at 12 months (p < 0.001). The est. BCVA improved from 1.50 ± 0.07 to 0.70 ± 0.07 logMAR at 12 months (p < 0.001). The est. ACD increased from 0.70 ± 0.06 to 3.34 ± 0.06 mm (p < 0.001), with complete anterior chamber reformation in all eyes. Postoperative complications occurred in 22 eyes (41.8%), mostly transient and resolved with medical or YAG laser treatment; only one required glaucoma surgery. At 12 months, overall success was 98.1% using the ≤21 mmHg criterion and 75.5% using the ≤18 mmHg criterion. No relapses were observed.

Surgical management using lens removal, endoscopic anterior vitrectomy, and hyaloido-zonulo-iridectomy is a significantly effective and safe treatment for AM.